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General NPI Number Information
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NPI Number | 1821980509
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Entity Type | Individual
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Provider Name | KEISHA RONNELLE LOPEZ NP
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Gender | Female
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Dates
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Enumeration Date | 07/17/2025
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Last Update Date | 11/11/2025
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Provider Practice Location Address
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Address Line | 5309 COMMONWEALTH CENTRE PKWY STE 105
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City | MIDLOTHIAN
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State | VA
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Zip | 23112-2633
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Country | US
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Telephone | 804-215-6555
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Fax |
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Provider Business Mailing Address
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Address Line | 11100 STERLING COVE DR
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City | CHESTERFIELD
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State | VA
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Zip | 23838-5158
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Country | US
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Telephone | 804-482-9400
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 0024193916
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License Number State | VA
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